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Biomedical subjects

R E Marshall

Publications and source records attributed to R E Marshall.

At least 37 records · Page 2Linked to original sources
PubMed1995

Does pre-scan oxygen improve ultrasonic imaging of the pancreas?

Ultrasonic imaging of the pancreas is often impaired by overlying bowel gas. Oxygen therapy has, in the past, been shown to be effective in reducing the gas in the cysts of pneumatosis coli. Using the same hypothesis, a randomized, single blind study comparing ultrasonic imaging of the pancreas with and without prior oxygen therapy was carried out. Fifty-eight consecutive patients with acute abdominal complaints were randomized to two groups: Group 1, control - no oxygen (n = 30, 14 male, 16 female, mean age 61.9 +/- 17.8 years); Group 2, treatment (n = 28, 14 male, 14 female, mean age 61.4 +/- 14.5 years) received oxygen therapy (100% humidified at 101/min for 8-10 h prior to the ultrasound). Pancreatic visualization was graded good, moderate or poor. Mean paO2 in Group 1 was 10.9 +/- 1kP and in Group 2 was 36 +/- 10.5kP (P < 0.001 unpaired t-test). Pancreatic visualization was: GOOD-Group 1, 8; Group 2, 19; MODERATE - Group 1, 8; Group 2, 4; POOR - Group 1, 14; Group 2, 5. Oxygen therapy is a safe, cheap, non-invasive method of improving pancreatic visualization and may act by reducing overlying bowel gas.

Abdomen, Acute↗
PubMed1991

A controlled clinical trial of local anesthesia for lumbar punctures in newborns.

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.

Anesthesia, Local↗
PubMed1989

Neonatal pain associated with caregiving procedures.

This article presents evidence that newborns react to aversive caregiving procedures--heelsticks, circumcision, and surgery--with distinct physiological, behavioral, and metabolic responses. These responses are similar to those associated with pain in adults. Suggestions are made on methods of ameliorating the infant's responses to aversive caregiving procedures.

Analgesics↗
PubMed1988

Self-directed learning: the Wizard of Oz syndrome.

Every adult who embarks on a new project undergoes some self-directed learning. During the search for solutions, individuals may react in varied ways; yet, a basic syndrome of behavioral activities underlies these individual reactions. We have named this the "Wizard of Oz" syndrome because of the similarity it bears to the events in that classic fantasy. When developing interactive programs, producers should be cognizant of this behavior which characterizes the adult learner.

Adult↗
PubMed1988

Newborn pain cries and vagal tone: parallel changes in response to circumcision.

Clinical studies have demonstrated that the cries of chronically stressed, medically compromised infants are characteristically higher and more variable in pitch than those of healthy infants. Other studies have indicated that the vagal tone of chronically stressed infants is significantly reduced in comparison to that of normal infants. A neural model of cry production has been proposed which suggests that decreased vagal tone among infants at risk may, in fact, be related to these increases in cry pitch. Using routine, unanesthetized circumcision as a model of stress, we were able to examine the relation between cry acoustics and vagal tone in normal, healthy newborns undergoing an acutely stressful event. Vocalizations, heart, and respiratory waveforms were continuously recorded from 49 (32 experimental; 17 control) 1-2-day-old, full-term infants during preoperative, surgical, and postoperative periods. Vagal tone, as measured by the amplitude of respiratory sinus arrhythmia extracted from heart period data, was significantly reduced during the severe stress of circumcision, and these reductions were paralleled by significant increases in the pitch of the infants' cries. In addition, individual differences in vagal tone measured prior to circumcision surgery were predictive of physiological and acoustic reactivity to subsequent stress. These results emphasize the potential role of vagal control of the autonomic nervous system during stress.

Acoustics↗
PubMed1986

Pregnancy and diabetes. Team approach.

Each year, 10,000 babies are born to diabetic women. Gestational diabetes occurs in 2% of all pregnant women, resulting in 60,000 to 90,000 cases of gestational diabetes yearly. Prior to 1922 and the discovery of insulin, fetal mortality for the pregnant diabetic was almost 100%. Today, total fetal mortality for the pregnant and gestational diabetic is approaching that of the nondiabetic. This has been achieved by extremely tight control of blood glucose levels throughout pregnancy, with blood glucose levels averaging under 100 mg/dL/day and glycosylated hemoglobin levels in the normal range throughout pregnancy. An increased number of malformations in fetuses of pregnant diabetic women is still a problem. However, animal and human studies indicate that a normal level of glycosylated hemoglobin at conception may significantly reduce these malformations.

Birth Weight↗
PubMed1986

Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency.

The relation between neonatal cry features elicited by painful circumcision procedures and the perceived urgency of those cries was investigated. Vocalizations were recorded during circumcision of 30 normal newborn males, analyzed by spectrographic methods and validated with computer techniques. The most invasive procedures elicited significantly longer crying bouts; shorter quiet intervals; shorter, more frequent vocalizations; higher peak fundamental frequencies; fewer harmonics; and greater variability of the fundamental. Cries elicited by the most intrusive procedures were judged by adult listeners to be the most urgent, and cries from similarly invasive procedures were judged to be of the same degree of urgency. Cries appeared to be judged along 3 dimensions described by harmonic, temporal, and pitch characteristics. Subjective judgments and objective quantitative data converge to demonstrate that infants' cries are perceived as varying and, objectively, do systematically vary with respect to the intensity of painful stimuli.

Arousal↗
PubMed1985

Effect of phenobarbital on motor activity and intraventricular hemorrhage in preterm infants with respiratory disease weighing less than 1500 grams.

The use of prophylactic phenobarbital to reduce motor activity and intraventricular hemorrhage was investigated in a controlled exploratory trial with 19 low birthweight premature infants with respiratory disease. Although phenobarbital significantly suppressed movement, it was associated with an increased incidence of intraventricular hemorrhage (IVH). Phenobarbital-treated infants were over eight times more likely to experience IVH than were untreated infants. These data indicate that inhibition of motor activity by phenobarbital may not alleviate the key pathogenetic factors in IVH.

Apgar Score↗
PubMed1984

Stress and coping strategies of nurse managers in the NICU.

Nursing managers in neonatal intensive care units must cope with numerous stresses that arise in the context of managing a complex medical unit. Ten nurse managers were interviewed using a structured interview to determine the frequency of interaction and the sources of stress that occur in working with physicians, hospital administration, nursing administration, and staff nurses. Physicians are a major source of stress but the issues vary depending on the role held by the nurse manager. The unwillingness of the staff nurse to appreciate the time involved in implementing any change is another major source of stress. Numerous coping strategies are being implemented to address identified sources of stresses. The intent of these strategies is to reduce stress by increasing the flow of task-relevant communication to all parties.

Adaptation, Psychological↗
PubMed1982

Circumcision: II. Effects upon mother-infant interaction.

The effects of circumcision upon mother-infant interaction were examined in an observational study of 59 mother-infant pairs during hospital feedings on days 2 and 3 of life. Each pair was observed during 4 hospital feedings using a specifically designed mother-infant interaction observation system that examined 43 discreet behaviours relating to feeding, gaze, facial expression, vocalizations and touch. The experimental group was circumcised after the second feeding and the control group after the fourth feeding. Analysis revealed no major behavioral differences between the experimental and control groups. Yet, different trends between the two groups were observed regarding two variables shortly after surgery. These differences disappeared by 24 h post-operatively. Differences related to the frequency of feeding intervals and infant availability scores. The study also revealed a surprisingly limited repertoire of behavior exhibited by both the mother and infant during feeding sessions. Our data suggest that circumcision has brief and transitory effects on mother-infant interactions observed during hospital feeding sessions, the only time mothers who are not rooming-in have an opportunity to be with their infants.

Adult↗
PubMed1982

Auditory brainstem responses in preterm neonates: maturation and follow-up.

Seventy-five neonatal intensive care unit patients with given auditory brainstem response screening tests at 40 db and 70 db above the normal adult hearing threshold. The presence of wave V, the criterion for pass, was strongly related to postconceptual age: It appeared at 70 db in 50% of the infants tested at 32 weeks' PCA and at 40 db in 50% of the infants tested at 40 weeks' PCA. Forty-four infants failed the last test before NICU discharge (15 at 70 db and 29 at 40 db), but most infants were discharged at a PCA of less than 40 weeks. No significant correlation appeared between ABR test failure and intraventricular hemorrhage, hyaline membrane disease, perinatal asphyxia, hyperbilirubinemia, or aminoglycoside therapy. Follow-up information was obtained in 23 of the 36 "failing" infants who survived (8 died). This consisted of definitive hearing tests in ten patients and historical information supporting normal auditory function in 13 patients. One case of severe hearing loss was confirmed. Thus, most failures of the ABR screen apparently resulted from immaturity. These data raise doubts regarding the effectiveness of ABR screening in the NICU.

Age Factors↗
PubMed1982

Terminal deletion of the long arm of chromosome 10 : q26 to qter. Case report and review of literature.

This communication describes the fourth known patient with a terminal long arm deletion of chromosome 10. The karyotype is : 46,XX,del(10)(q26). The clinical findings in the patient included intrauterine growth retardation, microcephaly, truncus arteriosus type 1, respiratory distress and craniofacial dysmorphism. Although review of the limited number of patients with a similar deletion reveals several common features, there is yet insufficient evidence to define a distinct 10q--syndrome.

Abnormalities, Multiple↗
PubMed1980

Auditory function in newborn intensive care unit patients revealed by auditory brain-stem potentials.

The relations between clinical illness and auditory response (as revealed by auditory brain-stem potentials) were prospectively studied in a neonatal intensive care unit. Forty-nine tests were performed on 29 infants with gestational age 24 to 43 weeks and birth weight 530 to 3,380 gm. Auditory test results were classified as pass or fail, depending on the presence or absence of wave V at a latency of 7 to 11 ms in response to clicks 60 dB above the normal adult threshold. Six patients failed and 23 patients passed. The failures were not correlated with excessive noise exposure or ototoxic medication. Five of the patients who failed had intracranial hemorrhage. Routine screening of infants in the NICU for auditory impairment is a clinically feasible and useful procedure.

Brain Stem↗